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Aesthetic Plastic Surgery Jun 2024Rhinoplasty is one of the most popular aesthetic plastic surgeries worldwide. The effects of tranexamic acid (TXA) in patients undergoing rhinoplasty are still being... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rhinoplasty is one of the most popular aesthetic plastic surgeries worldwide. The effects of tranexamic acid (TXA) in patients undergoing rhinoplasty are still being studied to guide a better management.
METHODS
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) analyzing the effects of TXA in patients undergoing rhinoplasty. The outcomes evaluated were blood loss, postoperative edema, postoperative ecchymosis, surgery duration and surgeon satisfaction.
RESULTS
Eleven studies comprising 841 patients were included. Overall, TXA reduced total blood loss regardless of dose and administration route (MD = - 39.37 mL; 95% CI = - 62.70 to - 16.05 mL; p = 0.0009; I = 92%), using intravenous 10 mg/kg of TXA preoperatively (MD = - 16.30 mL; 95% CI = - 29.49 to - 2.57 mL; p = 0.02; I = 61%) and using 1 g of oral TXA preoperatively (MD = - 61.70 mL; 95% CI = - 83.02 to - 40.39 mL; p < 0.00001; I = 0%). TXA also decreased edema (MD = - 0.78; 95% CI = - 1.28 to - 0.27 points; p = 0.003; I = 80%) and ecchymosis (MD = - 1.13; 95% CI = - 1.99 to -0.28; p = 0.01; I = 93%) on postoperative day one (POD 1). Surgeon satisfaction was increased (SMD = 1.55; 95% CI = 0.33 to 2.77; p = 0.01; I = 95%). However, there was no difference in surgery duration (SMD = - 0.26; 95% CI = - 0.56 to 0.04; p = 0.09; I = 36%).
CONCLUSION
This study found a significant reduction in blood loss, periorbital edema and periorbital ecchymosis, along with an improvement in surgeon satisfaction. These results hold the potential to optimize the rhinoplasty management by plastic surgeons.
LEVEL OF EVIDENCE I
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Adult; Female; Humans; Male; Antifibrinolytic Agents; Blood Loss, Surgical; Ecchymosis; Randomized Controlled Trials as Topic; Rhinoplasty; Risk Assessment; Tranexamic Acid; Treatment Outcome
PubMed: 38097691
DOI: 10.1007/s00266-023-03768-3 -
Canadian Journal of Ophthalmology.... Apr 2024To describe the manifestations and treatment of extraocular muscle (EOM) bacterial pyomyositis.
OBJECTIVE
To describe the manifestations and treatment of extraocular muscle (EOM) bacterial pyomyositis.
DESIGN
A systematic review following PRISMA guidelines and a case report.
METHODS
PubMed and MEDLINE databases were searched for case reports and case series of EOM pyomyositis using the term "extraocular muscle" combined "pyomyositis" and "abscess". Patients were included as bacterial pyomyositis of the EOMs when there was a response to antibiotics alone or if a biopsy was consistent with the diagnosis. Patients were excluded when pyomyositis did not involve the EOMs or when diagnostic tests or treatment were not in keeping with the diagnosis of bacterial pyomyositis. An additional patient with bacterial myositis of the EOMs, treated locally, was added to the cases identified in the systematic review. Cases were grouped for analysis.
RESULTS
There are 15 published cases of EOM bacterial pyomyositis including the one reported in this paper. Bacterial pyomyositis of the EOMs typically affects young males and is caused by Staphylococcus species. Most patients present with ophthalmoplegia (12/15; 80%), periocular edema (11/15; 73.3%), decreased vision (9/15; 60%) and proptosis (7/15; 46.7%). Treatment involves antibiotics alone or in combination with surgical drainage.
CONCLUSIONS
Bacterial pyomyositis of the EOM presents with the same signs as orbital cellulitis. Radiographic imaging identifies a hypodense lesion with peripheral ring enhancement within the EOM. An approach to cystoid lesions of the EOMs is helpful in reaching the diagnosis. Cases can be resolved with antibiotics aimed at treating Staphylococcus, and surgical drainage may be required.
Topics: Male; Humans; Pyomyositis; Oculomotor Muscles; Abscess; Exophthalmos; Anti-Bacterial Agents
PubMed: 36863408
DOI: 10.1016/j.jcjo.2023.02.001